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MD2 Foundation > Stroke and TIA > Flashcards

Stroke and TIA Flashcards

1
Q

What is the second leading cause of death worldwide?

A

Stroke

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2
Q

What is dysphasia?

A

Language disorder
Deficiency in generation of speech
Sometimes also comprehension
Due to brain disease/damage

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3
Q

What is expressive dysphasia?

A

Difficulty in putting words together to make meaning

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4
Q

What is receptive dysphasia?

A

Difficulty in comprehension

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5
Q

What is dysarthria?

A

Speech disorder caused by disturbance of muscular control

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6
Q

What is dysphonia?

A

Difficulty speaking due to physical disorder of

  • Mouth/
  • Tongue/
  • Throat/
  • Vocal cords
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7
Q

What does the acronym FAST stand for?

A 
F - facial weakness
- Can person smile
- Has mouth/eye drooped
A - arm weakness
- Can person raise both arms?
S - speech difficulty
- Can person speak clearly and understand what you say?
T - time to act fast
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8
Q

Why is it important to know the exact time of onset of symptoms in stroke?

A

Because treatment available very time critical

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9
Q

How can you assess facial droop?

A

Asymmetry in nasolabial folds

If subtle, get patient to smile

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10
Q

What type of lesion is indicated if the upper half of the face is spared?

A

Upper motor neuron lesion on contralateral side

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11
Q

What type of lesion is indicated if the whole half of the face is affected?

A

Lower motor neuron lesion on ipsilateral side

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12
Q

How can arm drift be used to assess weakness in an arm in the assessment of a possible stroke?

A

Ask patient to close eyes and hold out both arms, palms facing up
Arm on weaker side pronates and drifts downwards

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13
Q

What type of dysphasia Broca’s dysphasia?

A

Expressive

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14
Q

What type of dysphasia is Wernicke’s dysphasia?

A

Receptive

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15
Q

What is a silent stroke?

A

May not have much of deficit
May be difficult to elicit deficit if present even 1 hour later
Still have tissue infarction on imaging

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16
Q

Define stroke

A

Brief episodes <24 hours with brain injury

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17
Q

Define transient ischaemic attack (TIA)

A

Brief neurological episodes, usually <24 hours, without damage on imaging

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18
Q

What does a code stroke in the emergency department mean?

A 
Urgent triage and high priority
Mobilise stroke team
IV
- Glucose
- Routine biochemistry
- Full blood exam (FBE)
ECG
Accurate clinical diagnosis
- Exclude mimics
Urgent CT
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19
Q

Why is blood glucose measured in a possible stroke patient?

A

Hypoglycaemia = great mimic, especially of stroke

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20
Q

Why is an FBE performed in a stroke patient?

A 
Platelet levels
- If known coagulopathy
- On anticoagulant
Include INR
Both assess risk of bleeding because of thrombolysis
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21
Q

Why is a CT scan performed?

A

To exclude haemorrhage
Doesn’t matter if you accidentally thrombolyse a TIA/stroke mimic
- But important not to thrombolyse haemorrhage

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22
Q

When does thrombolysis lose its benefit-to-risk ratio?

A

After 4.5 hours

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23
Q

How do you predict a stroke has occurred, and not a mimic?

A 
Exact time of onset
Patient could recall exactly what they were doing when symptoms started
Well in last week
Definite focal symptoms/signs
Worse NIH stroke score (NIHSS)
24
Q

How do you predict a mimic has occurred, and not a stroke?

A 
Known cognitive impairment
Lost consciousness/seizure at onset
Patient could still walk
No lateralising symptoms
Confusion
Non-vascular, or no neurological signs
25
Q

Does a CT scan help in the diagnosis of a stroke?

A

No, remains clinical diagnosis
Scan done only to exclude haemorrhage
Signs of infarct can take up to 72 hours to develop

26
Q

What are the three major stroke types?

A

Ischaemic stroke = cerebral infarction
Intracerebral haemorrhage
Subarachnoid haemorrhage

27
Q

What are the common types of ischaemic stroke?

A 
Large artery thromboembolism
Cardiogenic embolism
Small vessel (lacunar) infarction
Rarer causes
Unclassified/cryptogenic
28
Q

What are the common types of intracerebral haemorrhage?

A

Deep hypertensive location

Lobar

29
Q

What are the common types of subarachnoid haemorrhage?

A

Aneurysm
Arteriovenous malformation
Other

30
Q

What is a larger artery thromboembolism?

A

Cortical infarction
More than 50% relevant large artery stenosis
Absence of cardiac source

31
Q

What is a cardiogenic embolism?

A

Cortical infarction
Cardiac source
Absence of large artery disease

32
Q

What is the most common cardiac source of a cerebral infarction?

A

Atrial fibrillation

33
Q

What is a lacunar infarction?

A

Subcortical infarction
Absence of large artery/cardiac source
Clinical syndromes

34
Q

What are some rare causes of ischaemic stroke?

A

Arterial dissection
Drugs
Vasculitis
Rarer arteriopathies; eg: Moyamoya disease

35
Q

What is the most lethal stroke subtype?

A

Haemorrhage

36
Q

What is a deep intracerebral haemorrhage?

A 
Putamen
Thalamus
Brainstem
Cerebellum
Usually due to hypertension and rupture of deep penetrating arteries
37
Q

What is a lobar intracerebral haemorrhage?

A 
Superficial
Often secondary to
- Amyloid angiopathy
- Tumour
- Arteriovenous malformation
- Aneurysm
38
Q

What does stroke evolution result in?

A

Increased lesion volume > worse outcome

39
Q

What is the aim of therapies for ischaemic stroke and intracerebral haemorrhage?

A

Limiting stroke growth

40
Q

What is IV tPA?

A

Thrombolytic

41
Q

What is hemicraniectomy?

A

Skull flap removed for some days, allowing swelling to subside

42
Q

What are the non-modifiable risk factors for ischaemic stroke?

A 
Age
Gender
Family history
Ethnicity
Contraceptive use
43
Q

What are the established modifiable risk factors for inschaemic stroke?

A 
Hypertension
Diabetes
Smoking
Atrial fibrillation/heart disease
Hypercholesterolaemia
Alcohol consumption
Prothrombotic factors
Prior TIA
Prior stroke
44
Q

What are the possible modifiable risk factors for ischaemic stroke?

A 
Physical inactivity
Obesity
Dietary factors
Infection
Stress
Sleep apnoea
Socioeconomic status
45
Q

What are the main modifiable risk factors for ischaemic stroke?

A

Smoking
Hypertension
Diabetes
Obesity

46
Q

Do antihypertensive drugs reduce the risk of primary stroke?

A

Yes, by 40%

47
Q

Is there an indication for antiplatelet treatment in ischaemic stroke?

A

No clear indication in low-intermediate risk

In high risk, consider aspirin

48
Q

Does warfarin decrease the risk of stroke?

A

Yes

49
Q

What are the classes of the new oral anticoagulants?

A

Direct thrombin inhibitor

Factor Xa inhibitors

50
Q

What is the drug class of dabigatran?

A

Direct thrombin inhibitor

51
Q

What is the drug class of rivaroxaban?

A

Factor Xa inhibitor

52
Q

What is the drug class of apixaban?

A

Factor Xa inhibitor

53
Q

What is the advantage of the new oral anticoagulants over warfarin?

A

Less likely to cause intracerebral haemorrhages

54
Q

What is the CHADS2 scoring system?

A

Measure for calculating risk of haemorrhage

55
Q

How is secondary prevention carried out in stroke?

A

Tailored to stroke pathogenesis in individual

56
Q

When should secondary prevention for stroke start?

A

In hospital

57
Q

Describe in general terms the secondary prevention of stroke

A 
Lower blood pressure
Control cholesterol with statins
Antiplatelet therapy
Control atrial fibrillation with anticoagulation
Carotid revascularisation
- Endarterectomy
- Stenting

MD2 Foundation (42 decks)

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